More than 30,000 Canadians have died of drug overdoses in the past seven years, with almost 8,000 of those deaths occurring in the past year alone.
We’ve become inured to people falling prey to toxic drugs by the score, most visibly on the streets of urban centres, but also at work, at parties, and alone in their homes.
Drugs like opioids (fentanyl, Oxycodone, heroin, etc.), methamphetamines, benzodiazepines, cocaine and more – and, increasingly combinations of them – are being injected, smoked, snorted, and inhaled, often with grave consequences.
We know how to address this epidemic of preventable deaths and destruction – at least on paper.
There are four pillars to a robust response to drug problems: prevention, harm reduction, treatment and enforcement.
This comprehensive approach was masterfully articulated in “A Framework for Action: A Four-Pillar Approach to the Drug Problems in Vancouver,” a strategy paper authored by Donald Macpherson when he was the drug policy co-ordinator for the City of Vancouver back in 2001.
The strategy worked well at first. In Vancouver, overdose deaths fell from 400 to below 200 annually over the next decade, mostly due to public health measures like needle exchanges, the first supervised injection site (Insite), supportive housing, health services for homeless people and more.
But the drug crisis changed over time. Heroin gave way to diverted prescription opioids and then synthetic opioids, like fentanyl, arrived on the streets in the mid-2010s. In the 2020s, the situation became more complex as fentanyl and its analogues were increasingly tainted with other substances, like benzodiazepines. In B.C. alone, there have been 11,000 overdose deaths in the past seven years.
Not knowing exactly what drug you are using greatly increases the risk of overdose, and the mishmash of drugs makes overdose treatments like naloxone less effective. Users have also increasingly shifted from injection to inhalation, but policy responses have not kept up. We still have more supervised injection sites than supervised consumption sites. And we haven’t progressed from clean needles to clean drugs (known as safe supply.)
The socioeconomic environment has also become more complex. There is a housing crisis (particularly a lack of low-cost and supportive housing.) There is more homelessness, more poverty, more trauma, more people living with pain, and more desperation, often contributing to more and more varied drug use.
The pandemic, which hit hardest on the margins of society, and which made an already fragile health system more so, only exacerbated the challenges.
Meanwhile, street drugs are cheaper, easier to find, and more toxic than ever.
Most of all though, we seem to have abandoned the four pillars approach – prevention, harm reduction, treatment, enforcement. We wavered in our response instead of doubling down. We’ve turned to finger-pointing instead of co-ordination.
The response to the drug crisis has become increasingly polarized. There are those who think enforcement, and enforcement alone, is the answer. There are those advocating for a laws-be-damned approach to harm reduction.
Illness should not be criminalized. But using drugs – even being addicted – does not give you a free pass to do whatever you want, either.
The prevention component of the four pillars is almost non-existent right now. In our beleaguered mental health non-system, treatment simply isn’t there for people who need it.
So, what are we left with? A lot of flailing about with no overall strategy.
We tear down encampments where drug users have taken refuge.
Using a harm-reduction lens, this is justified given the risks of fire and the violence, disorder, and economic disruption surrounding these camps. But there is not adequate housing for everyone, which is harmful.
Then there is violence, with random attacks on city streets and public transit, often perpetrated by people with untreated mental illness and substance-use disorder.
The response? Calls for more police, bail reform and involuntary treatment. More enforcement. But, again, there is little investment in treatment as an alternative, which is costly but not as costly as throwing people in jail.
Then there is the magical thinking about safe supply, that giving everyone high-quality, untainted drugs will solve everything. It would likely cut overdose deaths, but it won’t clear the streets, increase interest in rehab or reduce substance misuse.
A good, effective drug policy should balance public health and public order. It should reduce the negative impact of drugs on individuals and communities.
A public health emergency of this magnitude requires an emergency response, one with a suite of complementary measures, not simplistic solutions.
André Picard